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Trainee-Authored Letters to the Editor

Beyond USMLE Step 1

Haider, Syeda Razia

Author Information
doi: 10.1097/ACM.0000000000002136
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To the Editor: Anyone familiar with medical education knows it is full of transitions—from baccalaureate training to medical school, from preclinical to clinical education, from medical school to residency, and so on. However, one transition that is rarely discussed is the transition from the United States Medical Licensing Exam (USMLE) Step 1 “break” back to normal life.

Most medical schools give students a month or two after their second year of medical school to study for the USMLE Step 1. Doing well on this exam is extremely important for a medical student’s future, so I spent a lot of time studying intensely. This was the first time I had to really organize my studying, and I did so in more rigorous ways than I had ever done before. I had prepared for other standardized exams, such as the Scholastic Aptitude Test or Medical College Admissions Test, over several months, but the USMLE was unique due to the extensive amount of information assessed. I had accumulated a great deal of knowledge over the first two years of medical school, but still spent about 10 to 12 hours per day studying meticulously. I did not have adequate conversations with people. Every text or phone call felt like an enormous burden since I would rather have been reading a study guide or doing practice questions. Sometimes, I even forgot to engage in basic human activities, such as eating or relaxing. This unrelenting focus was inevitable given how much rested on the score of this single test.

When I walked out of the exam, I felt a sense of profound emptiness. I erupted from a void dissociated from reality. Life seemed surreal and chaotic. Amidst the nervousness of anticipating my score, I had to reestablish lost human connections and catch up on other things such as managing my finances and my own doctor’s appointments.

This sudden transition became a healthy time to reflect upon my future as a doctor. Starting third year, I felt an incredible need to be professional, organized, and on schedule. I used the transition from the USMLE break back to everyday life as a time to rethink my relationships with others. I contemplated how to achieve a healthy work–life balance during high-pressure situations. I tried to develop adequate communication skills with family and friends so they would not feel shut out. I worked to develop an extensive support network, so I would not feel shut out. I restructured my association with my reality. After all, my future professional life as a physician will involve similar times of intense work and concentration.

Syeda Razia Haider
Third-year medical student, Weill Cornell Medicine–Qatar, Education City, Al Luqta St, Ar-Rayyan, Qatar;; ORCID:

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